1st January Research Articles

Survival rate changes in children with congenital diaphragmatic hernia over the past three decades: a nationwide, population-based prospective nested case-control study.

The survival rate (SR) for neonates born with congenital diaphragmatic hernia (CDH) remains high. Our aim was to investigate the change in SR in children with CDH over the past decades. The study was a nationwide, population-based prospective nested case-control study within a cohort of newborn children who was born in Sweden during the observational period from 1st January 1982 to 31st December 2015. In the study period, 4654 (99.6%) control children and 684 children with CDH (70.4%, p < 0.001) were with a survival of 2years of age. Any patients who were born with CDH had a overall 5.8 times higher chance for not surviving 2years of age than children without CDH. The SR improved significantly in CDH in the past 3 decades. Significantly higher number of patients were prematurely born in the CDH group than in the controls (23.3 vs 6.1%, p < 0.001). The SR of premature and non-premature born CDH patients has increased significantly over the past 3 decades. The SR of CDH patients were significantly increased in the past 3 decades. The 2-year survival remains 5.8 times higher than those who were not born with CDH. These changes were mainly attributed to the improved SR of premature and non-premature born CDH patients.

Unsung Heroes in Sabah’s Historiography: The Indigenous Community in the Anti-Japanese Movement in North Borneo, 1942–1945

The Petagas War Memorial, erected in 1946, is the official symbol of Sabah’s anti-Japanese resistance between 1942 to 1945. The memorial focuses on the predominantly Chinese Kinabalu Guerrilla Defence Force (KGDF), which managed to secure vital assistance and cooperation from Sabah’s peribumi (indigenous) community. However, it does not adequately capture their contributions despite becoming the backbone of KGDF. Without them, the anti-Japanese movement would not have run smoothly nor achieved any form of success (albeit short-lived). On the 21st of January, the war memorial hosts an annual commemoration of KGDF against Japan. However, it tends to ignore the contributions of indigenous fighters. Therefore, this study seeks to examine the recognition that should have been given to Sabah’s indigenous fighters against the Japanese occupation in Sabah, exploring the cooperation between Sabah’s indigenous community and the KGDF in the anti-Japanese movement between 1942 and 1945. The aim is to place the role of former fighters in its proper context. This study is based on library research as well as interviews. The primary resources from the library research are derived from reports, files and newspapers found in the Sabah State Archives. Interviews are utilised to complement archival sources, especially in the absence of written records.

Correlation of IGF2 levels with sperm quality, inflammation, and DNA damage in infertile patients.

Insulin-like growth factor 2 (IGF2) is a critical endocrine mediator implicated in male reproductive physiology. To investigate the correlation between IGF2 protein levels and various aspects of male infertility, specifically focusing on sperm quality, inflammation, and DNA damage, a cohort of 320 male participants was recruited from the Women's Hospital, Zhejiang University School of Medicine (Hangzhou, China) between 1st January 2024 and 1st March 2024. The relationship between IGF2 protein concentrations and sperm parameters was assessed, and Spearman correlation and linear regression analysis were employed to evaluate the independent associations between IGF2 protein levels and risk factors for infertility. Enzyme-linked immunosorbent assay (ELISA) was used to measure IGF2 protein levels in seminal plasma, alongside markers of inflammation (tumor necrosis factor-alpha [TNF-α] and interleukin-1β [IL-1β]). The relationship between seminal plasma IGF2 protein levels and DNA damage marker phosphorylated histone H2AX (γ-H2AX) was also explored. Our findings reveal that IGF2 protein expression decreased notably in patients with asthenospermia and teratospermia. Correlation analysis revealed nuanced associations between IGF2 protein levels and specific sperm parameters, and low IGF2 protein concentrations correlated with increased inflammation and DNA damage in sperm. The observed correlations between IGF2 protein levels and specific sperm parameters, along with its connection to inflammation and DNA damage, underscore the importance of IGF2 in the broader context of male reproductive health. These findings lay the groundwork for future research and potential therapeutic interventions targeting IGF2-related pathways to enhance male fertility.

Could piano music therapy alleviate high sinus rhythm in subjects with controlled hypertension?

Abstract Background/Introduction With a millenary tradition, music is rediscovered nowadays, as adjuvant therapy. The number of beats per minute (bpm) is the common factor of cardiology – representing heart rate (HR), and music – reprezentative for tempo. Purpose Our goal was the HR modulation in patients (pts) with moderate tachycardia using three piano kits: K1 – Adagio by Albinoni, K2 – Piano Concerto nr. 21 by Mozart, second part; and K3 – Liebestraum by Liszt. Methods During 1st January – 31st December 2023, we identified by ambulatory screening 288 pts adequate for our goal. As exclusion criterion, we considered any type of rhythm or conduction dysturbances. All selected pts were controlled with antihypertensive agents not altering HR, usually thiazide/thiazide-like diuretics and/or ACEis/ARBs. The study group consisted in 144 hypertensive pts controlled at least six months, without any other cardiac diseases. The control group consisted in 144 pts with normal cardiologic examination. Both groups were demographically balanced. The HR at admission was between 84 and 120 bpm, the pts being stratified in three bpm subcategories. All pts have done three visits consisting in: physical examination, ECG, lab markers, TTE for V1 at initiation and EoS at six months, and respectively, physical exam and ECG for V2 at 3 months. Results (in bpm): Inside the group with HR 84-96 treated with K1, the Controlled HTN group (CHG) and the Normal Cardiac group (NCG) alleviated HR from 85,8 +/- 12,6 to 82,6 +/- 12,2; and from 85,7 +/- 12,6 to 80,8 +/- 11,9, respectively. For pts inside the interval 97-108 treated with K1, the CHG group and the NCG alleviated HR from 94,3 +/- 14,1 to 90,9 +/- 13,7 and, respectively, from 94,4 +/- 14,1 to 89,7 +/- 13,6. In pts from HR spectrum 97-108 treated with K2, the CHG and the NCG alleviated HR from 98,4 +/- 14,6 to 95,7 +/- 14,1; and from 98,5 +/- 14,6 to 94,1 +/- 13,8; respectively. Inside the group with HR spectrum 109-120 treated with K1, the CHG and the NCG alleviated HR from 97,1 +/- 14,3 to 94,8 +/- 13,9; and, respectively, from 97,0 +/- 14,3 to 93,9 +/- 13,7. For pts inside the interval 109-120 treated with K2, the CHG and the NCG alleviated HR from 101,7 +/- 14,6 to 99,3 +/- 14,2; and from 101,8 +/- 14,6 to 97,3 +/- 14,1; respectively. In pts from HR spectrum 109-120 treated with K3, the CHG and the NCG alleviated HR from 106,1 +/- 14,7 to 103,8 +/- 14,6; and from 106,5 +/- 14,4 to 103,6 +/- 14,4; respectively. Conclusions The effect of piano music on HR seems favorable in controlled hypertensive pts without major comorbidities, probably by interfering the sympathetic vegetative nervous system. In this regard, it could be used as adjuvant in optimizing this cardiac parameter. However, a multicentered randomized clinical study will be needed.

Metformin is associated with lower risks of incident cancers compared to sulphonylurea use: a population-based study with competing risk analyses

Abstract Objective To investigate the effects of sulphonylurea compared to metformin on the risks new-onset cancers and mortality in patients with type 2 diabetes mellitus. Methods This is a retrospective population-based cohort study of patients with type 2 diabetes mellitus between 1st January and 31st December 2009 with follow-up until 31st December 2019. Propensity score matching (1:2 ratio) between metformin and sulphonylurea users was performed. The primary outcome is new diagnosis of any cancer. The secondary outcomes are cancer, cardiovascular, or all-cause mortality. Cox regression was used to identify significant predictors. Competing risks were considered using cause-specific or subdistribution hazard models. Propensity score stratification, inverse probability weighting, and high-dimensional propensity score adjustment were also used. Results In the matched cohort, 36487 sulphonylurea and 71306 metformin users were included. Univariable Cox regression showed that compared to metformin users, sulphonylurea users had a higher risks of any new cancer diagnosis (hazard ratio [HR]: 2.26, 95% confidence interval [CI]: 2.18-2.34, P&amp;lt;0.0001), including pancreatic (HR: 4.03 [3.37, 4.82], P&amp;lt;0.0001), colorectal (HR: 2.12 [1.97, 2.27], P &amp;lt;0.0001), genitourinary (HR: 1.73 [1.57, 1.90], P&amp;lt;0.0001), breast (HR: 1.36 [1.22, 1.51], P&amp;lt;0.0001) and lung cancer (HR: 3.37 [3.11, 3.65], P&amp;lt;0.0001) cancers. Sulphonylurea users also had higher risks of cancer-related (HR: 2.38, 95% CI: 1.87-3.03; P&amp;lt;0.0001) and all-cause mortality (HR: 1.92, 95% CI: 1.78 -2.08; P&amp;lt;0.0001). Conclusion Metformin use was associated with lower risks of new diagnosis of any cancer, cancer-related and all-cause mortality in patients with type 2 diabetes mellitus.Figure 1.Study flow diagram.FIgure 2.New diagnosis of cancer.

Increased frailty is associated with risk of hospital-acquired infections and death during heart failure hospital admissions

Abstract Background Frailty is common in patients admitted with acute decompensation of heart failure (ADHF) and it is unclear how the frailty syndrome affects heart failure (HF) patients during their acute hospital admission. Understanding the interplay between frailty, impaired renal function, hospital-acquired infections (HAI), and death may be useful in optimising patient care and prognosis. Purpose The aim of this analysis was to explore the relationship between admission frailty levels and the incidence of HAI, acute kidney injury (AKI), and mortality in acute HF hospital admissions. Methods This is a retrospective analysis of data submitted from a single centre to the National HF audit between January and June 2023. Additional frailty and baseline renal function data was retrospectively collected from electronic patient health records. Patients were categorised into three groups according to their Rockwood Clinical Frailty Scale (CSF) (1): no/mild frailty (CFS 1-3), moderate frailty (CFS 4-6) and severe frailty (CFS 7-9). AKI was defined based on baseline and admission creatinine, as per KDIGO guidelines (2). Chi-squared and t-tests were used to compare baseline characteristics between frailty groups. Chi-squared tests were used to compare frailty groups in terms of: HAI, AKI, mortality. Results Between 1st January and 22nd June 2023, there were 344 acute HF hospital admissions in our centre. Most patients had moderate frailty on admission (n=256, 74.4%). Frail patients were significantly older, had a lower admission mean haemoglobin and more were female, compared to non-frail patients (Figure 1A). Patients who were more frail were more likely to experience HAI during their admission; p=0.035 (figure 1B). Furthermore, patients with HAI had a greater risk of mortality, at a median follow-up of 171 (IQR 100.25) days after admission, compared to those without HAI (p&amp;gt;0.001). 41.9% of acute HF admissions were associated with an AKI, and although numerically more frail patients had an AKI, this did not achieve statistical significance (p=0.084). Patients who were more frail were more likely to die, both during hospital admission and at 3 months following discharge; p&amp;lt;0.001 (Figure 1B). Furthermore, this trend persisted after follow-up; p&amp;lt;0.001 (Figure 2). Conclusions Patients with moderate or severe frailty are at greater risk of adverse events (HAI, death) during an acute HF hospital admission, than patients with no or mild frailty. It is imperative to consider the frailty status of all patients with ADHF, to be aware of the frailty-associated risks, and act proactively with targeted interventions (screen for infections, daily bloods, early conversations with patients and their families about treatment escalation plans and patient priorities) to improve outcomes and enhance the quality of care for this vulnerable patient population. Further research is warranted to explore potential interventions to address frailty-related risks in HF management.

ChineseCVD: a web-based Chinese-specifi c cardiovascular risk calculator incorporating long COVID, COVID-19vaccination, SGLT2i and PCSK9i treatment effects

Abstract Background Web-based risk prediction tools for cardiovascular diseases are crucial for providing rapid risk estimates for busy clinicians, but there is none available specifically for Chinese subjects. This study developed ChineseCVD, a risk calculator for cardiovascular disease. Methods Adult patients attending government-funded family medicine clinics in Hong Kong between 1st January 2000 and 31st December 2003 were included. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attacks/ischaemic strokes, and cardiovascular mortality. Results A total of 155,066 patients were used as the derivation cohort. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) had MACE. Cox regression identified male gender, age, comorbidities, cardiovascular medications, systolic and diastolic blood pressure, and laboratory test results (neutrophil-lymphocyte ratio, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL) as significant predictors of the above outcomes. ChineseCVD further incorporates the impact of smoking status, COVID-19 infection, number of COVID-19 vaccination doses, and modifier effects of newest medication classes of PCSK9i and SGLT2i. The calculator enables clinicians to demonstrate to patients how risks vary with different medications. Conclusions The ChineseCVD risk calculator enables rapid web-based risk assessment for adverse cardiovascular outcomes, thereby facilitating clinical decision-making at the bedside or in the clinic.

Achieving integrated care through clusters of co-occurring diseases for people with multimorbidity

Abstract Background People with multimorbidity are often seen in many different specialist health services, resulting in fragmented care. Conventional services are designed around specialties based on anatomical systems, rather than diseases that occur together. We examined whether organising services around clusters of co-occurring diseases would lead to fewer interactions with unique services and so improve integrated care. Methods We used the Clinical Practice Research Datalink, a nationally representative sample of primary care data in England, including all patients registered on 1st January 2015 with multimorbidity (two or more of 212 long-term conditions (LTCs)). We used the assignment of 212 LTCs to 15 clusters of co-occurring diseases, derived from our earlier work. For each patient, we calculated the number of interactions with different specialists, under both the existing specialty-based model, and the hypothetical cluster-based model, under the assumption that a patient required review for each LTC. Results Of 6,200,973 patients with multimorbidity, the mean age was 53 years, with a median (interquartile range) of 8 (5 - 11) LTCs per person. There was considerable variation in the assignment of diseases comparing 15 clusters versus 15 specialties. Under the existing model, 409,708 (6.6%) patients interacted with only one specialty, and under the hypothetical cluster model, 584,446 (9.4%) patients interacted with only one cluster. On average, patients interacted with 3.66 specialties versus 3.30 hypothetical clusters (p &amp;lt; 0.001 for difference). Conclusions Health services designed around clusters of co-occurring diseases might lead patients to interact with fewer different services and so experience less fragmented care. Further work is needed to understand which specialties collaborating, and how, would have the greatest impact on improving integrated care. Key messages • Health services designed around clusters of co-occurring diseases led to a small reduction in the number of interactions with different services per year. • Designing services around clusters of co-occurring diseases might reduce fragmented care for people with multimorbidity.

Vaccine-preventable diseases in migrants to Europe: a systematic review

Abstract Migrant populations in Europe are at increased risk of under-immunisation and therefore likely to be at high risk of vaccine-preventable diseases (VPD), yet the relationship between migration and VPD incidence is not fully understood. This study aimed to explore the prevalence of VPDs in migrant populations in Europe and to define at-risk groups. Following PRISMA guidelines, Embase, MEDLINE and Global Health were searched for peer-reviewed papers published from 1st January 2010. Inclusion criteria comprised primary research on VPD cases (measles, mumps, rubella, diphtheria, pertussis, tetanus) among migrants to/within EU/EEA and Switzerland. We defined migrants as foreign-born nationals. Forty-seven eligible studies from 15 EU/EEA countries and Switzerland were included, with a total of 1357 migrant VPD cases reported. Analysis revealed 1357 migrant cases across measles (28 publications; 926 cases), pertussis (9; 267 cases), mumps (9; 107 cases), diphtheria (11; 67 cases), rubella (2; 6 cases imported from Romania and Pakistan), tetanus (2; 2 cases). Over-representation of measles cases was observed among migrant children and adolescents, predominantly from the WHO Europe region (particularly Bulgaria, Bosnia and Herzegovina and Serbia). Migrants of East African origin were over-represented among diphtheria cases. This study underscores the association between migration and VPD cases in EU/EEA and Switzerland, establishing a clear association between European migrant children and adolescents in measles outbreaks, and adult migrants from East Africa in diphtheria cases. This study suggests strengthening systems for targeted catch-up vaccination for migrants is imperative upon arrival in European countries to align them with national schedules, alongside the need to improve data collection and surveillance systems to inform effective public health interventions. Key messages • Migrant populations in Europe face heightened risk of vaccine-preventable diseases and need to be better incorporated into catch-up vaccination initiatives on arrival. • Improved data collection and surveillance systems are crucial for informing effective public health interventions targeting migrant populations.

Remote monitoring and prioritisation for patients awaiting transcatheter aortic valve implantation safely mitigates longer waiting times

Abstract Background • The UK National Health Service (NHS) faces an unprecedented backlog of over 400,000 patients awaiting critical cardiac procedures, incurring thousands of excess deaths (1). • Longer waiting times to transcatheter aortic valve implantation (TAVI) can increase rates of unplanned hospitalisation and death (2). • Remote patient monitoring (RPM) can improve cardiovascular clinical outcomes (3), but its effectiveness in detecting and managing TAVI waiting list deterioration is untested. Purpose 1. Measure the systemic increase in waiting time to TAVI 2. Determine if RPM and prioritisation: · Is acceptable to patients · Detects clinical deterioration · Mitigates the expected increase in adverse events associated with longer waiting times · Does not unfairly disadvantage patients who are not prioritised Methods • We performed an observational cohort study including all patients awaiting TAVI at one UK regional centre between 24th April and 15th November 2023. • Patients were supported to complete an online or telephone-based weekly symptom questionnaire. • Responses were monitored by non-specialist nurses staffing a 'hub', with rule-based escalation to the TAVI team, who could prioritise treatment (Figure 1). • A historical control cohort who did not receive RPM was identified, as sequential unselected patients on the TAVI waiting list in reverse order, from 24th April 2023 to 1st January 2023. This cohort was propensity score-matched to adjust for age, sex, ethnicity and comorbidities. • Waiting time was defined as the date difference between a patient being placed on the waiting list and TAVI completion. • We defined patient acceptability as &amp;gt;80% engagement with at least one symptom questionnaire. • Sensitivity was calculated as the percentage of escalations to the TAVI Consultant resulting in prioritisation. • Kaplan-Meier survival analysis was performed for the primary endpoint of adverse events, defined as emergency department presentation, unplanned hospitalisation or death. Results • The median waiting time to TAVI increased by one month (104 days versus 75 days, p&amp;lt;0.001). • There was 99% (200/202) engagement with RPM • Despite the increased waiting time, there was no significant difference in rate of adverse events between the propensity score-matched RPM and historical control groups (12.5% versus 13.7%, p=0.86) (Figure 2) • 87% (27/31) of escalations to the TAVI Consultant resulted in treatment prioritisation • There was a non-significant difference in median waiting time between prioritised and non-prioritised patients during the study period, but with no clinical consequence to the delay (97 versus 120 days, p=0.16). Conclusions • An RPM pathway can detect patient deterioration on TAVI waiting lists with high sensitivity • RPM-based prioritisation for patients awaiting TAVI can mitigate the increased risk of adverse events associated with longer waiting times, without unfairly disadvantaging non-prioritised patients.Figure 1.RPM pathwayFigure 2

Long-term outcomes in women diagnosed with heart failure in connection to delivery

Abstract Background Heart failure (HF) among young patients may be from various causes, often triggered by heightened physical demands like pregnancy. Data regarding outcomes of women diagnosed with HF in conjunction to pregnancy and delivery are varied. There remains a notable gap in understanding the outcomes observed in women diagnosed with heart failure in conjunction with delivery. Also, long-term follow-up studies are crucial to elucidate the impact of pregnancy-associated HF on future cardiovascular. Purpose To study the interplay between pregnancy, HF, and subsequent cardiovascular risk. Method Using the personal identification numbers (PINs) that all individuals in Sweden have enables linkage of data between different registers. Data from the National Patient Register (NPR), Swedish Medical Birth Register (MBR) and the Cause of Death Register were also used. All women 18 to 50 years of age registered in the in MBR in the period 1st January 1997 to 31st December 2019 were included. Women with first-time HF in relation to delivery were identified using the international classification code for diseases (ICD-10) I50, I42, I43 and 090.3 together with co-morbidities. Every patient was compared with 5 controls without HF from the Total Population Register matched on age at delivery and calendar year of delivery. Outcomes: all-cause mortality, and any cardiovascular disease (CVD) diagnosed during the observation time. Results A total of 286 cases and 1,430 controls were included. The prevalence of comorbidities at baseline for both patients and controls was low; congenital heart disease (1.4%, vs. 0%), pulmonary hypertension (1.0% vs. 0%), valvular heart disease (5.9% vs. 0%), myocardial infarction 0.7% vs. 0%), arrhythmia (5.9% vs. 0%), hypertension (6.3 % vs. 0.1%), (all p&amp;lt;0.05). Preeclampsia prior to HF diagnosis had 31% of patients vs. 0.2% of controls (p&amp;lt;0.001). Patients exhibited higher mortality rates at 4.9% during median follow up 9.0 (IQR 5.6-13.0) years vs. 0.3%, median follow up 9.4 (6.2-13.5) years and hazard ratios (HR) for all-cause mortality HR (95% CI) of 18.20 (5.99 - 55.31) (p&amp;lt;0.001) compared to controls. During median follow up of 3.2 (0.0-9.2) years 60.1% of patients were diagnosed with CVD both at in-/out-patient settings compared with 4.1% in controls during 9.4 (5.8-13.5) years of follow up. Comparing patients with controls the HR (95% CI) was 22.24 (16.50 - 29.96) p&amp;lt;0.0001 for CVD diagnosis during follow-up, see Figure 1. Conclusion In conjunction with delivery, and in the years thereafter, women with heart failure diagnosis had more than eighteen times higher risk of mortality than women without heart failure. The risk of CVD event in the heart failure group is highest in conjunction with delivery. Figure 1. Cumulative incidence functions for all-cause mortality, CVD in- or out-patient visit adjusted for death as competing risk, comparing cases with controls.

Estimated number of COVID-19 deaths averted by vaccination in Belgium

Abstract Background Vaccination campaigns have been rolled out globally to limit the impact of COVID-19 on severe health outcomes, including mortality. We aimed to estimate the number of averted deaths by COVID-19 vaccination in the Belgian population aged ≥65 years, between January 2021 and January 2023. Methods Nationwide data on COVID-19 infections, vaccinations and all-cause mortality were individually linked. We estimated Vaccine Effectiveness against COVID-19 mortality (VE) in persons having received a vaccine dose in the last 6 months using a Cox proportional hazards model adjusted for age, sex, time since vaccination, previous infection, comorbidities, province and income. COVID-19 death was defined as a death within 1-7 weeks after a positive SARS-CoV-2 laboratory-test. Based on obtained VE estimates, vaccine coverage and national COVID-19 mortality data, we estimated the number of averted deaths (expected deaths without vaccinating minus the reported deaths). Results By January 31st 2023, 11,033 COVID-19 deaths have been reported in Belgium. The average vaccine coverage was 48% during alpha, 85% during delta and 63% during omicron dominance. VE was estimated at 0-59 days after vaccination, for 65-79 year and ≥80 year-olds respectively, at 65% (58%-60%) and 35% (28%-41%) during Alpha, at 84% (82%-87%) and 79% (77%-81%) during Delta and at 83% (80%-85%) and 71% (68%-73%) during Omicron dominance. We estimated 10,042 deaths averted (range: 8,917-11,188) among the Belgian population aged ≥65 years, representing a 48% reduction (range 45%-50%) in the expected deaths. Out of 10,042 averted deaths, the majority was averted during Delta (47%; 4,670) or Omicron dominance (43%; 4,366), compared to during Alpha dominance (10%; 1,006). Conclusions Vaccinating against COVID-19 led to an important reduction in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance, underscoring the effectiveness of vaccines against mortality. Key messages • Vaccinating against COVID-19 led to an important reduction of 48% in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance. • Vaccine effectiveness against COVID-19 mortality was estimated as high in the Belgian population ≥65 years (range: 71-84%) during Delta and Omicron dominance, also among elderly over 80 years.

Clinical characteristics of patients with moderate or severe valvular heart disease

Objective: To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD). Methods: This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1st January 2001 to 1st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results: A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions: There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Risk factors for developing residual stress urinary incontinence after vesico-vaginal fistula repair: A retrospective cohort study

BackgroundPrevious studies have identified predictors for residual urinary incontinence after successful closure of fistula. However, these findings remain uncertain because the predictors vary from one study to another. The present study aimed to examine the risk of residual stress urinary incontinence after successful closure of vesico-vaginal fistula (VVF). Materials and methodsWe conducted a multicenter retrospective cohort study over 07-years period, from 1st January, 2010 to 31 December, 2016. We included women who underwent VVF repair in one of the seven fistula centers. At three months postoperatively, a cough test was performed among patients who had their fistula successfully closed. The predicted outcome was the urinary continence status after sussessful closure of the fistula and was categorized as (Residual stress urinary incontinence and No Residual stress urinary incontinence). Multivariable binary logistic regression model was performed to analyze association between outcome and predictors. ResultsOverall fistula closure rate at 3 months was 88.6% (404/456). Of the patients who had their fistula successfully closed, 16.3% (66/404) experienced a residual stress urinary incontinence. Risk factors for residual stress urinary incontinence in univariate analysis were: urethro-vesical junction involvement, circumferential fistula, Goh type 3, fistula size greater than 3cm, previous fistula repair, urethra involvement. Three independent predictors have been identified: urethro-vesical junction involvement, previous fistula repair and type 3 of Goh's classification. ConclusionThis study showed that the rate of residual stress urinary incontinence is high in our setting. The involvement of sphincteric mechanism is the main predictor.

Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry.

To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS. Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022). UK NHS hospitals treating RRP patients. Children and adults diagnosed with RRP and managed in an NHS hospital. Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death). Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period. This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time. NCT03465280, ISRCTN36100560.

Worldwide Sodium Channel Conference, January 31st–February 2nd, 2024, Grindelwald, Switzerland

Worldwide Sodium Channel Conference, January 31st–February 2nd, 2024, Grindelwald, Switzerland

Teachers’ experiences of enacting pedagogical models and models-based practice: a systematic mixed study review

ABSTRACT Background The shift from traditional, teacher-led methods towards more student-centred approaches in many countries has positioned pedagogical models and Models-based Practice (MbP) as a potential future for physical education pedagogy. Over the last 10–15 years there has been a surge in publications reporting on teachers’ experiences of enacting models. These studies have not, until now, been synthesised. Such a synthesis would allow a richer, more nuanced and holistic understanding of teachers’ experiences of enacting pedagogical models in physical education. This understanding helps to provide a robust evidence base from which to consider the usefulness of pedagogical models and MbP as a future physical education pedagogy. Purpose The purpose of this review is to explore and synthesise teachers’ experiences of enacting pedagogical models in literature from 2010 to 2022. In doing this we set out to answer the question: What are teachers’ reported experiences of enacting pedagogical models and/or models-based practice? Methods This study employed a systematic mixed study approach to analyse empirical examples of qualitative, quantitative, and mixed methods research published between 1st January 2010 and 31st October 2022. The selection process involved a comprehensive search strategy across four databases (SportDiscus, ERIC, Web of Science, Scopus), title and abstract screening, full-text evaluation, the use of the mixed methods assessment tool and a synthesis of the findings from the 91 included studies. Results The findings highlighted five themes related to teachers’ experiences of enacting pedagogical models: (1) developing democratic classrooms through pedagogical models, (2) enacting pedagogical models for professional growth, (3) strengthening student learning within and beyond the physical domain, (4) aligning curricula through pedagogical models, and (5) challenging the current state of physical education through pedagogical models. Results reveal teachers’ efforts to democratise the classroom environment where students, regardless of their ability, were given equal opportunities. This democratisation occurred alongside teachers’ pedagogical growth but was not without its challenges. The review underscores the multifaceted challenges of integrating pedagogical models into diverse educational contexts. Teachers report on the need for investment in professional development and the garnering of other professional support to be able to negotiate and adapt pedagogical models to the curricular aspirations in local contexts. Importantly, the review highlights how many teachers reported that their use of pedagogical models allowed them to extend student learning beyond the physical domain. Discussion The review makes an important, original and innovative contribution to understanding and knowledge in the field by highlighting the potential of pedagogical models to enrich physical education pedagogy by fostering more inclusive, reflective, and dynamic learning environments. It critically examines the barriers in the enactment of pedagogical models, ranging from infrastructural limitations to the intricacies of using pedagogical models in practice. The paper, therefore, highlights the need for supportive frameworks for teachers implementing pedagogical models that emphasises continuous learning and collaboration. In conclusion, we ask if pedagogical models are destined to remain a lofty ideal, or if there is a need to recalibrate our scholarly compass, broadening our research horizons to envisage a more inclusive and diverse future for physical education?

Epidemiologic trends and clinical outcomes of imported malaria in a tertiary care hospital, Bangkok, Thailand: A retrospective analysis (2013–2022)

BackgroundDespite a significant declined in malaria incidence in Thailand, the rising global travel has resulted in an increase of imported malaria cases, posing a threat to the goal of malaria elimination. This study aims to understand the epidemiological trends and clinical outcomes of imported malaria cases in Thailand. MethodsMedical records of all imported malaria cases admitted from 1st January 2013 to 31st December 2022 at the Hospital for Tropical Diseases, Thailand, were retrospectively examined. Demographic data, travel details, severity of illness, and clinical outcomes were described. Logistic regression was performed to identify factors associated with severe disease outcomes. ResultsIn total, 335 cases of imported malaria were identified, with 33 % classified as transnational malaria and 67 % as border malaria. Transnational malaria cases (79 % P. falciparum) were mostly acquired from Sub-Saharan Africa for business or visiting friends and relatives (VFRs). Border malaria cases (81 % P. vivax) involved unskilled labourers and were acquired from land-border countries. The proportion of imported malaria in business travelers increased from 13 % to 50 % over the ten years. Risk factors for severe imported malaria included male gender, age 40 and older, infection with P. falciparum, and acquired malaria from Africa. ConclusionsUnderstanding unique demographic and socioeconomic characteristics in both border and transnational cases is crucial for effective malaria prevention. The increasing imported malaria among business travelers highlight the need for targeted prevention in this high-risk group.

The decriminalization of illicit drugs in British Columbia: a national evaluation protocol

BackgroundOn January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC’s decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy.MethodsThe following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC’s decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored.ResultsThe overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study.DiscussionThis evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation’s evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization.

Benefits of emergency department routine blood test performance on patients whose allocated triage category is not time critical: a retrospective study

IntroductionEmergency department clinicians, and particularly nurses in triage, frequently perform routine blood tests on patients whose allocated triage category is not time critical (triage categories 3, 4 and 5 of the Australasian Triage Scale). Some observers have questioned the utility of routine blood testing in these acute healthcare settings given the cost and workload implications.MethodsA quantitative method using retrospective observational design was utilised guided by STROBE checklist. Electronic medical records of patient data collected at a quaternary Australian metropolitan hospital emergency department were reviewed.Results and discussionA total of 74,878 adult patients attended the emergency department between 1st January and 31st December 2021 and a sample of 383 were randomly allocated for this study. Of the 383 patients included, 51% were female, age ranges were 18–99 years (mean 51.6). The majority were Australasian Triage scale (ATS) triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p < 0.001) but not with department occupancy as determined by the national emergency department overcrowding scale (p = 0.230).ConclusionBlood testing in the emergency department in triaged non-time critical patients was found to be frequent thereby affecting nurses’ already stretched time resource. Older patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the emergency department.